The NHS Counter Fraud Service

The NHS Counter Fraud Service (NHS CFS) works to reduce fraud against the NHS. This releases valuable resources for patient care and services.
 
The NHS CFS is responsible for:

• Revising policy and processes to prevent fraud.
• Providing information to target action where it is most needed.
• Identifying the nature and scale of the problem of NHS fraud and corruption.
• Setting and monitoring the standards of NHS counter fraud work.

Each NHS trust in England and local health board in Wales has a Local Counter Fraud Specialist (LCFS) assigned to it. LCFSs are supported by staff in the NHS CFS’s regional teams, which take on the higher-value cases and provide support and advice to LCFSs on the cases they are taking forward.

Our services

The NHS CFS investigates fraud, provides policy advice and support to the Department of Health and stakeholders, provides guidance to NHS bodies and trains and accredits LCFSs.

We seek to:

• Create an anti-fraud culture.
• Maximise the deterrence of fraud.
• Prevent fraud
• Detect fraud quickly
• Professionally investigate detected fraud.
• Apply effective penalties, including legal action.
• Restore money defrauded.

We cannot achieve these aims alone. For this reason, we have agreements with regulatory and professional bodies representing more than one million NHS staff and contractors.

Local Counter Fraud Specialists

At a local level, LCFSs are responsible for the delivery of counter fraud work within NHS health bodies. Strengthening the anti-fraud culture is a major part of their work. On a day-to-day basis, this work includes:

• Developing and maintaining close working relationships with all relevant parties, including the NHS CFS and its internal and external stakeholders, and the health body’s internal and external audit functions.
• Delivering presentations and other counter fraud communications to a range of audiences, including staff and professional groups.

National Fraud Initiative

This authority is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing or administering public funds, in order to prevent and detect fraud.
 
The Audit Commission appoints the auditor to audit the accounts of this
authority. It is also responsible for carrying out data matching exercises. Data matching involves comparing computer records held by one body against other computer records held by the same or another body. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it indicates that there is an inconsistency which requires further investigation. No assumption can be made as to whether there is fraud, error or other explanation until an investigation is carried out.
 
The Audit Commission currently requires us to participate in a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Audit Commission for matching for each exercise, and these are set out in the Audit Commission's handbooks, which can be found on the Audit Commission website.

The use of data by the Audit Commission in a data matching exercise is carried out with statutory authority under its powers in Part 2A of the Audit Commission Act 1998. It does not require the consent of the individuals concerned under the Data Protection Act 1998.
 
Data matching by the Audit Commission is subject to a code of practice.

 For further information on the Audit Commission's legal powers and the
reasons why it matches particular information, see the Level 3 Notice on the Audit Commission website or contact Peter Yetzes, Head of NFI on 0844 798 2222 or email nfiqueries@audit-commission.gov.uk

How can I report a fraud (or suspected fraud) taking place in the NHS?

• Call the NHS fraud and corruption reporting line on freephone 0800 028 40 60.Lines are open 8.00am–6.00pm Monday to Friday.
• Contact the LCFS for East Cheshire NHS Trust, Beric Dawson on 0161 304 5803 or  beric.dawson@anw.nhs.uk   
• Fill in the online fraud reporting form at www.reportnhsfraud.nhs.uk
• Ask your LCFS for advice. Contact details are available from the relevant NHS trust.